What's it going to take to Test fresh patients, page-5

It comes down to money and a fear of failure.

You want your drug to come to market as soon as possible so you want to establish that it works superior to or at least is non-inferior to another similar step in the treatment algorithm. This would mean that you have to choose patients who would be eligible for that other treatment. If you chose patients pre-chemo/immuno then you're not comparing it to the standard treatment algorithm and you're introducing bias and scientists will say your study hasn't shown anything because there's no stats we can use to compare the two experimental arms.

Instead what we'll do is pick a cancer, pick a treatment, compare our drug to that, confirm superiority/non-inferior and establish a market and an income stream then we can afford to choose another cancer or maybe compare using our drug first line instead of second line or something. Nivolumab was approved for use in Australia like 6 or something years ago but to this day they're applying for use in new cancers or lines of therapy as they establish more evidence.

If you went for the top rung of the ladder straight away and you miss then you've tarnished your reputation and your drug and if you're a small company you can't afford to do that.